Hepatitis B used to get no play. But earlier this year, it made the headlines when scientists discovered that it's the oldest virus known to affect humans -- at least 8,000 years old. And now Stanford scientists are trying to draw policymakers' attention to the disease.
Hepatitis researchers here published a study this week in Health Affairs that examined the cost effectiveness and public health impact of incrementally increasing the diagnosis, care and treatment of hepatitis B in the United States. The findings indicate that by reaching the World Health Organization's targeted goals five years early -- by 2025 -- nearly 50 percent of all hepatitis B related deaths in the United States could be avoided.
Mehlika Toy, PhD, a scientist in Stanford's Asian Liver Center, helped build the predictive model and is lead author of the paper. The WHO calls for diagnosing 90 percent of those with hepatitis B and administering treatment to 80 percent of those patients that need it. "We had to figure out how to get the current United States diagnosis rate of 35 percent up to 90 percent," she told me.
Getting rates of diagnoses up requires focusing on populations with the highest incidence of the disease. "Most of the cases are adults who have migrated from high-endemic countries in Southeast Asia and Africa," said Toy. Since the U.S. census data no longer includes country of origin, the scientists had to focus on race. Concentrating interventions in black and Asian immigrants between the ages of 25 and 54 is cost effective, the study found.
Another factor that led to the success of the model came as a surprise in December. "We never imagined that the cost of the drug would go down 90 percent when the patent ran out and a generic version became available," Toy said. Lowering the price of treatment made the plan not only cost effective but cost saving.
"Now we want to know if it would still be cost effective to target a broader audience," Toy said, by testing all black and Asian people of a particular age -- not only immigrants. It would be much easier to implement, since place of birth is not part of primary care medical records.
Toy and her co-authors want to encourage government mandated screenings, which have proven effective for other conditions. For example, the state of New York requires doctors to offer hepatitis C screening to baby boomers, who account for three quarters of the hepatitis C infected population. In the first year after the law was passed, there was a nearly 40 percent increase in new diagnoses, according to Samuel So, MD, founder of the Asian Liver Center and the paper's senior author.
I asked Toy what it would take to get the information from her report into policy. "I've been doing this for over 10 years, and I can tell you that policy change does not happen overnight," she said. Other things may have priority, and there are always budget limits.
The impact on public health is clear, but the findings need to be put in the right hands. That's one of the reasons that the results are being published in the journal Health Affairs. "We didn't want the results to get lost in a journal specific to hepatitis or liver specialists -- they know that there's a hepatitis B problem. Better instead to get it in front of a broader audience covering private and public sectors where it can have maximum impact," Toy said.
David Hutton, PhD, associate professor of health management and policy at the University of Michigan, is a co-author of the study.
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